Calyceal Cutaneous Fistula

Connor Deal

February 2013

• HPI: 73 year old female with recurrent right flank abscess s/p drainage (3/2012, 9/2012) who presents with further work-up of recurrent abscess – suspicion for enterocutaneous fistula. No fevers/chills.

• PMH: HTN, CKD, Nephrolithiasis, DVT (2/2012), DM

• PSH: Kidney stone removal (1969), Right flank abscess drainage (3/2012, 9/2012), av fistula placement (7/2012), ivc filter (2/2012)

• PE: Vitals: WNL; Gen:AOx3; Back:Guaze/Tegaderm over R-flank abscess with milky/yellowish purulent drainage. Slightly tender.

• Labs: BUN: 55; Bicarb: 15; Creat: 4.16; WBC 14.86

History

• We know there is an abscess.• Is there a fistula?

DDx

ACR Criteria for suspected abscess

TIMELINE

March 2012 drain R flank

abscess2/4/2013Admission

2/5/201312:20pm

Fluoroscopy

2/5/20132:30pm

Ultrasound

2/5/20139:14pm

CT Abdomen

2/6/2013IR Drainage

Sept 2012 drain R flank

abscess

Fluoro Sinogram Fistulogram GI tract only

-Prior to full injection of contrast

What is this?

5193023

Fluoro Sinogram Fistulogram GI tract only

5193023

5193549

CT Abdomen W/O IV contrast – Coronal View

5193549

CT Abdomen W/O IV contrast – Saggital View

Air bubble?

• IR drain placed by IR – 1 month duration• flagyl and levaquin – for diverticulitis• Followup• Future of kidney?

Outcome

• 65 yo female with right flank pain found to have complete right staghorn calculus with nephrocutaneous fistula.

• Fistula found by retrograde pyelogram which also confirmed the need for complete right nephrectomy.

Case Report (1990)

Figure 3: Right retrograde pyelogram shows the pelvic calcification outside the ureter and a fistulous tract between the renal pelvis and the skin.

• Charles JC. Nephrocutaneous fistula. J Natl Med Assoc. 1990;82 (8): 589-90. PMID PMC2626966

Reference